Humans ; Spinal Fusion ; Spine ; surgery

Humans ; Lumbar Vertebrae ; surgery ; Spinal Diseases ; surgery ; Spinal Fusion

Adolescent ; Humans ; Scoliosis ; surgery ; Spinal Fusion ; methods

OBJECTIVETo put some improvements to the traditional transforaminal lumbar interbody fusion (TLIF) and discuss its clinical significance.

METHODSCompleted the traditional posterior lumbar interbody fusion (PLIF) and TLIF procedure in 12 fresh cadavers, dissect further to expose the surrounding anatomical structures, and put the modified TLIF surgery according to the anatomical findings. And simulated the operation in 12 fresh cadavers, analyzed its feasibility and potential advantages.

RESULTSThe early anatomical study found that the related nerve root was in a state of high tension and certain risk of injury when completed the traditional PLIF and TLIF surgery, and found certain operational area between the superior articular process and the midline structures of the spinous processes and interspinous ligaments. Put the modified TLIF surgical approach according to the anatomical findings, which the operating area is located in PLIF outside and TLIF inside. As the following words: Take a posterior-middle incision, preserve the supraspinous and interspinous ligaments, and the spinous processes, dissect the bilateral paravertebral muscle, expose lamina and facet joints, not including transverse process, and remove unilateral inferior two third lamina, inferior articular process and expose the articular surface of the superior articular process, then dispose the intervertebral space for interbody fusion obliquely in the unilateral approach. Successfully completed the modified TLIF procedure in 12 fresh cadavers, the results showed that the technique has the following advantages. (1) Only remove unilateral inferior two third lamina and inferior articular process, preserve the supraspinous and interspinous ligaments, and the spinous processes, not expose the transverse process. (2) Both central canal, and lateral recess and nerve root canal of the operative side can be decompressed effectively simultaneously. (3) Avoid excessive traction to the thecal sac and traversing nerve roots and decrease the injury rate due to the reservation of the midline structures and the oblique manipulation, and less injury rate of the exiting nerve root, because of not necessary to expose it routinely.

CONCLUSIONSThe modified TLIF is safe and feasible, could effectively reduce the nerve roots injuries. Maybe it's a better choice for most of the Chinese patients at present.

Adolescent ; Humans ; Scoliosis ; classification ; surgery ; Spinal Fusion ; methods

Adolescent ; Bone Transplantation ; methods ; Humans ; Scoliosis ; surgery ; Spinal Fusion ; methods

OBJECTIVETo study the relevant position of C(2) pedicle to C(2) inferior articular process, set up a technique of C(2) pedicle screw placement with the inferior articular process of axis as an anatomic landmark.

METHODSFifty C(2) bone specimens were used to measure the distance from the sagittal midline to the medial border, the midpoint and the lateral border of C(2) inferior articular process or C(2) pedicle; the width and the height of the C(2) pedicle were also evaluated. The anatomic relation between the measurements data of C(2) pedicle and that of C(2) inferior articular process were analyzed, and the technique of C(2) pedicle screw fixation was established.

RESULTSThe medial border of C(2) inferior articular process was averaged (3.67 +/- 0.41) mm lateral to that of C(2) pedicle, and the midpoint C(2) inferior articular process was averaged (1.15 +/- 0.44) mm lateral to the lateral border of C(2) pedicle, respectively. Using the C(2) inferior articular process as landmark, two techniques was established for C(2) pedicle screw placement. The entry point of method A was located in 2 mm medial and superior to the central point of C(2) inferior articular process; the entry point of method B was at the crossing point of the medial border C(2) inferior articular process with the superior quarter of C(2) inferior articular process.

CONCLUSIONSThere is a steady anatomic relation between C(2) pedicle and C(2) inferior articular process, the C(2) inferior articular process could be as a convenient key anatomic landmark to determine the location of C(2) pedicle and the position of C(2) pedicle screw entry point.

Spinal fusion surgery ; Homologous Grafts ; Skeletal bone ; Future

OBJECTIVE: To review the research progress of Modic changes and its influence on lumbar interbody fusion. METHODS: The domestic and foreign literature related to Modic changes and its influence on lumbar interbody fusion was extensively reviewed. The etiology of Modic changes was summarized, and the treatment measures of Modic changes on lumbar interbody fusion were discussed. RESULTS: The etiology of Modic changes is not clear, which may be related to mechanical factors, autoimmune factors, low toxic infection factors, and genetic factors. Modic changes may lead to fusion failure and cage subsidence after lumbar interbody fusion. Preoperative evaluation of endplate sclerosis, reduction of iatrogenic endplate injury, fine operating of intervertebral space, management of osteoporosis, and selection of appropriate cage can prevent or reduce fusion failure or cage subsidence. CONCLUSION Modic changes may lead to fusion failure and cage subsidence after lumbar interbody fusion, and active perioperative intervention of Modic changes is helpful to improve the clinical prognosis.
Humans ; Lumbosacral Region/surgery* ; Osteoporosis ; Spinal Fusion ; Treatment Failure

Biomechanical Phenomena ; Humans ; Motion ; Spinal Diseases ; physiopathology ; surgery ; Spinal Fusion ; Spine ; physiopathology ; surgery